INTRODUCTION: Maternal deaths increased in the United States during 2018-2021, with documented racial disparities. Respectful maternity care is a component of quality care that includes preventing harm and mistreatment, engaging in effective communication, and providing care equitably. Improving respectful maternity care can be part of multilevel strategies to reduce pregnancy-related deaths. METHODS: CDC analyzed data from the PN View Moms survey administered during April 24-30, 2023, to examine the following components of respectful care: 1) experiences of mistreatment (e.g., violations of physical privacy, ignoring requests for help, or verbal abuse), 2) discrimination (e.g., because of race, ethnicity or skin color; age; or weight), and 3) reasons for holding back from communicating questions or concerns during maternity (pregnancy or delivery) care. RESULTS: Among U.S. mothers with children aged <18 years, 20% reported mistreatment while receiving maternity care for their youngest child. Approximately 30% of Black, Hispanic, and multiracial respondents and approximately 30% of respondents with public insurance or no insurance reported mistreatment. Discrimination during the delivery of maternity care was reported by 29% of respondents. Approximately 40% of Black, Hispanic, and multiracial respondents reported discrimination, and approximately 45% percent of all respondents reported holding back from asking questions or discussing concerns with their provider. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Approximately one in five women reported mistreatment during maternity care. Implementing quality improvement initiatives and provider training to encourage a culture of respectful maternity care, encouraging patients to ask questions and share concerns, and working with communities are strategies to improve respectful maternity care.

The Black-White disparity in preterm birth persists and is not fully explained by individual-level social, behavioral, or clinical risk factors. Consequently, there is increasing emphasis on understanding the role of structural and area-level factors. Racialized-economic segregation measured as the index of concentration at the extremes (ICE) simultaneously captures extremes of deprivation and privilege. Our objective was to examine associations between preterm birth (PTB) and the index of concentration at the extremes (ICE). In this cross-sectional study, we analyzed 193,957 Florida birth records from 2019 linked to 2015-2019 census tract data from the American Community Survey. We assessed PTB (< 37 weeks gestation) by subtypes: (1) early (< 34 weeks) and late (34-36 weeks) and (2) spontaneous and indicated (i.e., provider-initiated) deliveries. We calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for three ICE measures: (1) ICE_INC: income, (2) INC_INC + WB: income + race/ethnicity (non-Hispanic White vs. Black), and (3) INC_INC + WH: income + race/ethnicity (non-Hispanic White vs. Hispanic). Results. For ICE_INC and INC_INC + WB, aORs for residing in the worst-off vs. best-off areas were 1.25 (95% CI: 1.12, 1.46) and 1.21 (95% CI: 1.07, 1.37) for early PTB, respectively, and 1.16 (95% CI: 1.05, 1.28) to 1.22 (95% CI: 1.12, 1.34) for indicated PTB. In conclusion, deprivation captured by ICE was associated with increased odds of early or indicated PTB. Eliminating PTB disparities may require a multifaceted approach that includes addressing the interplay between income and race/ethnicity in residential areas.

OBJECTIVE: Studies from Europe1 reported a reduction in the preterm birth rates early in the COVID-19 pandemic, but data from other world regions offered conflicting evidence.2 In the United States, evidence on preterm birth and stillbirth rates during the pandemic is also mixed.3,4 Existing studies were often limited to specific US hospitals or states or had missing information on stillbirths. We examined the temporal changes in US preterm birth and stillbirth rates by comparing the prepandemic rates with those during a period of reduced population movement (lockdown) and we investigated the geographic variation in the changes by census regions. | | STUDY DESIGN: We used IQVIA's PharMetrics Plus database (IQVIA, Durham, NC) a large convenience sample of claims data that included about one-fifth of US births covered by commercial health insurance, to compare rates between the lockdown period (AprilJune 2020) and a comparison prepandemic period (AprilJune 2019). We identified singleton delivery hospitalizations at 20 weeks gestation using International Classification of Diseases, Tenth Revision, and Current Procedural Terminology codes. We extracted information about the weeks of gestation and birth outcomes (live birth or stillbirth) for each delivery. Preterm birth rates (birth at <37 weeks gestation), late preterm birth rates (birth at 34 to 36 weeks gestation), and early preterm birth rates (birth at <34 weeks gestation) were examined. Stillbirth rates were also examined. We used a logistic regression to compare the birth outcome rates between the 2 time periods, adjusting for census region and maternal age. Although race and ethnicity data were available through data linkages for 12% of the sample, the missing or unknown category in the linked data was still more than 30%, limiting our ability to adjust for or stratify by this variable. We reported the adjusted rate measured in percentage point (%), adjusted rate difference (ARD), and adjusted rate ratio using predictive margins from each regression model. To examine geographic variation, we used interaction terms between the indicator variables for the time period and census region. | | RESULTS: Among 165,433 privately-insured women with singleton deliveries at 20 weeks gestation during the study periods, 0.2% were stillbirths, and 99.8% were live births; and of the live births, approximately 7% were preterm in both the time periods (Table 1). The adjusted rate of preterm birth during the 2020 lockdown was lower than the adjusted rate during the same months in 2019 (7.0% vs 7.4%; ARD=0.4%; 95% CI, 0.6 to 0.1). There was no change in the adjusted rate of stillbirth (ARD=0.02%; 95% CI, 0.07 to 0.02). The reduction in preterm birth was driven by the decrease in late preterm birth (ARD=0.3%; 95% CI, 0.6 to 0.1) (Table 2). The largest reduction in preterm birth was in the Northeast (ARD=1.1; 95% CI, 1.8 to 0.5) (Table 2).

BACKGROUND: The epidemiological and programmatic implications of inclusivity of HIV-positive males in voluntary medical male circumcision (VMMC) programs are uncertain. We modeled these implications using Zambia as an illustrative example. METHODS AND FINDINGS: We used the Age-Structured Mathematical (ASM) model to evaluate, over an intermediate horizon (2010-2025), the effectiveness (number of VMMCs needed to avert one HIV infection) of VMMC scale-up scenarios with varying proportions of HIV-positive males. The model was calibrated by fitting to HIV prevalence time trend data from 1990 to 2014. We assumed that inclusivity of HIV positive males may benefit VMMC programs by increasing VMMC uptake among higher risk males, or by circumcision reducing HIV male-to-female transmission risk. All analyses were generated assuming no further antiretroviral therapy (ART) scale-up. The number of VMMCs needed to avert one HIV infection was projected to increase from 12.2 VMMCs per HIV infection averted, in a program that circumcises only HIV-negative males, to 14.0, in a program that includes HIV-positive males. The proportion of HIV-positive males was based on their representation in the population (e.g. 12.6% of those circumcised in 2010 would be HIV-positive based on HIV prevalence among males of 12.6% in 2010). However, if a program that only reaches out to HIV-negative males is associated with 20% lower uptake among higher-risk males, the effectiveness would be 13.2 VMMCs per infection averted. If improved inclusivity of HIV-positive males is associated with 20% higher uptake among higher-risk males, the effectiveness would be 12.4. As the assumed VMMC efficacy against male-to-female HIV transmission was increased from 0% to 20% and 46%, the effectiveness of circumcising regardless of HIV status improved from 14.0 to 11.5 and 9.1, respectively. The reduction in the HIV incidence rate among females increased accordingly, from 24.7% to 34.8% and 50.4%, respectively. CONCLUSION: Improving inclusivity of males in VMMC programs regardless of HIV status increases VMMC effectiveness, if there is moderate increase in VMMC uptake among higher-risk males and/or if there is moderate efficacy for VMMC against male-to-female transmission. In these circumstances, VMMC programs can reduce the HIV incidence rate in males by nearly as much as expected by some ART programs, and additionally, females can benefit from the intervention nearly as much as males.